Food Insecurity During Pregnancy in French Guiana - Focus on Infant Feeding

The international literature has already demonstrated the benefits of breastfeeding (BF) in the short, medium and long term for the health of children and mothers alike. For children, breastfeeding helps to reduce mortality from infections, prevents hospitalisations, particularly for gastroenteritis and respiratory illnesses, and prevents diabetes and childhood obesity. Breastfeeding also plays an important role in children's cognitive development, with an impact on IQ and academic success. For mothers, not breastfeeding is associated with an increased risk of breast and ovarian cancer, type II diabetes, obesity and cardiovascular disorders. Similarly, the WHO recommends optimal feeding practices for infants up to 2 years of age, i.e. early initiation of breastfeeding to allow the child to receive colostrum, exclusive BF for 4 to 6 months, and the timely introduction of liquid, semi-solid or solid foods, the continuation of BF for up to 2 years and beyond, the consumption of age-appropriate infant formula (IF) as an alternative to breastfeeding, and a minimum acceptable intake of complementary food to breast or infant milk.

On a national scale, the 'first 1000 days' initiative (from the 4th month of pregnancy to the child's 2nd birthday) that emerged at the symposium on 23 September 2021 organised by Santé Publique France and the French Ministry of Solidarity and Health includes the objective of promoting good BF practices. Similarly, the 2019-2023 national nutrition and health plan (PNNS4) aims to increase the percentage of children breastfed at birth by at least 15% and to extend the median duration of total breastfeeding by 2 weeks. In French Guyana, the 2023-2028 regional health plan points out that perinatal indicators in the French overseas territories are worse than in mainland France, and that improving mother and child health must involve improving the environment in which children live during their first 1,000 days.

In 2005, an initial retrospective study of breastfeeding practices was carried out in western part of French Guiana and showed a rate of exclusive breastfeeding at 4 months of age of 3% and a rate of continued breastfeeding of 16.7% up to 1 year and 6.5% up to 2 years. Between 2010 and 2012, a prospective survey of the whole of French Guiana found an exclusive BF rate of 27% at 1 month, 9% at 3 months and 5% at 6 months. In the Epifane survey conducted in France between 2010 and 2012, the rate of exclusive breastfeeding at 1 month and 3 months was close to that in French Guiana (28% and 10% respectively), with an average duration of exclusive or predominant breastfeeding of 3 weeks.

The rate of continued breastfeeding for up to 1 year was estimated at 16% in the Guiana study, compared with 9% in France. The rate of mixed breastfeeding concerned 30% of women breastfeeding from the maternity hospital in French Guiana, compared with 20% in France. The main reasons for introducing bottles of infant formula (IF) in both French Guiana and France were the impression of a lack of milk (the child's feeling of dissatisfaction) and the return to work. On the other hand, almost 1 in 2 women in French Guiana stated that no healthcare professional had shown any interest in their breastfeeding at 1 month post-partum.

Since January 2023, the Nutri Pou Ti'moun study ('Nutri 1 project' ID-RCB 2022-A01772-41), carried out in 3 maternity units in French Guiana and involving 800 women who have given birth - the 'Nutri 1 women's group' - aims to take stock of women's food insecurity during pregnancy and to describe the medical consequences observed on the course and outcome of pregnancy and on infant health in the immediate post-partum period. In the course of this project, the links between vitamin and mineral deficiencies, heavy metal impregnation and maternal dietary diversification are being studied. In the Guianese context of multidimensional precariousness, the Guianese perinat network, in partnership with local and institutional players, aimed to set up a health and nutrition pathway from the 4th month of pregnancy in October 2023, comprising weekly workshops co-hosted by a health mediator (on diet, well-being, adapted physical activities and the promotion of breastfeeding) and the distribution of baskets of fresh, local fruit and vegetables.